1194 LINKSIDE CT FNCE20-0083 • •
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Deotr:�coab.us C�L) IS REQUIRED.
Job Address: 1 M )k�6(J C. Permit Number: f N C ZO S3
Legal Description '-Ppir)CQ I,�i ?atPi''11\ll 67Ic2- RE#
Valuation of Work(Replacement Cost)$ 17U) Heated/Cooled SF Non- Heated/Cooled
• Class of Work: New ❑Addition EAlteration JS.Repair EMove EDemo ❑Pool EWindow/Door
• Use of existing/proposed structure(s): ❑Commercial , Residential
• If an existing structure, is a fire sprinkler system installed?: EYes ( :No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) TY.Qo
Describe in detail the type of work to be performed:
P_Pyli)c.12 ttriko L-4)611451 Virg . (7' ( 4-Q1
Florida Product Approval# for multiple products use product approval form
Propert Owner Information _
Name r1(. Address LIN Liviot o ( j
City f - (Fy- 1r State 4-L. Zip L))3 3 Phone 1104 S3 ]•'d,)i c9L
l )U0'70� (
Owner r Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information rC oJ Xn �y,�
Name of Company Qualifying Agent
Address City State Zip
Office Phone Job Site Contact Number
State Certification/Registration# E-Mail
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer OR Exempt o Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS, etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county, and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
II'\,, (Ltit
J ( i nature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed4gfore me this (7ri+ day of Signed and sworn to (or affirmed) before me this day of
���•v.�.- , ,by J vi)N C, , by
Ifi�, 1-115-1-----
(Signature of Notary) (Signature of Notary)
Notary Public Salta d,'lorida
[ ] Personally Known OR John C Meyers [ ]Personally Known OR
kl Produced Identification A,; c":"'"510"GG 336484 [ ] Produced Identification
Expires 06/18!2073
A_ 'hi_ w's:2 5-731 157 C
VVV11C, IJuII\dCI AIIILIQYIL
HIGHLIGHTED IN
lillsCity of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.u5 PERMIT#:
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES
OWNER/ BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER
OF YOUR PROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A
LICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH
IS IN VIOLATION OF THIS EXEMPTION.
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING
TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT
TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON ISA LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITHrALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
ob Address: ' C) Li L,i14-c&L4 C (-9
)wner Name: if fAU,{�_ Phone Number: I� -- 37-Ord 3o).
Aailing Address: I t1 Y 3�w'I City: j T� r . { 'lam State: Fl Zip: ,?,__Z
Notarized Signature of Owner `i i 71,U1 ) ----1
-he forgoing instrument was acknowledged before me this )7T> day of A../‘••).S- , 20(9 1%, in the State of Florida, County
if .1),,vAk.._
ItNoterycPublic State atnende
w Ex
dr IMypCorrs�mGG33eaea Signature of Notary Public ,/i`^-' !`
r/r nm06/1eI2a23
[ ) Personally Known OR Produced Identification
Type of Identification: Cl- N.. L.,:).-.7);)c—t-1 ) -? S-6 OS-0
Updated 10/24/18
MIA a.
••,,AIAP SHOIFING BOUNDARY SURVEY OF
LOT 27, SELLA LINKSIDE UNIT 1 AS RECORDED IN PLAT BOOK 44, PACES 23 & 23A,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED T0:
MARY JANE ROYS
ABN AMR() MORTGAGE GROUP, INC
' '� RICHARD T. MOREHEAD 11 TLE & ESCROW, INC.
STEWART TITLE GUARANTY COMPANY
I
S 06•24'17" E LINKSIDE COURT z
04 29.87' (MEASURED) EAST
er O1 S 06'18'00" E (50.0' RTGM7 OF WAY)
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FOUND 1/2' IRON PPE / • A
STAMPED 'C?OASDElL LB 12O' / t r.
POINT OF COMPOUND 20.1'
CURVATURE ' 0
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FOUND 1/2'RCN PIPEmum mom PIPE
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NO IDEXTIFICATION STAMPED 'CflOASDELL LB 120' FENCE POST
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Cas' MEA1 N 06'18'00- W 65.00' (PLAT)
N 06'32'30" W 65.49' (MEASURED) LOT 29
LOT 28
REVOCABLE ENCROACHMENT AGREEMENT
**ALL INFORMATION
�� City of Atlantic Beach
HIGHLIGHTED IN GRAY
\;6 800 Seminole Road,Atlantic Beach,FL 32233 IS REQUIRED.
`�..,REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized and
existing under the laws of the State of Florida, hereinafter referred to as "CITY"and
4- i' r v"f 1 of Atlantic Beach, Florida, hereinafter
referredto s "USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon
the property for the purpose as described in the City of Atlantic Beach.
This work is generally described as 11.L.9
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to
relocation or removal on thirty(30)days'notice by CITY to USER,said notice to USER shall be given by certified mail,return
receipt requested,to the following address
• In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter
upon the above described easement or property of the CITY, the USER shall replace at the USER's sole expense,
any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing or
adding to of the utilities and facilities of the CITY or franchise utility provider.
• The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land
Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h)
which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must
be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks."
• The USER, prior to making any changes from the approved plans and/or method, must obtain written approval
from the City of Atlantic Beach Public Works Department, for said change within 30 days after the day of
completion.
• This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and
assigns.
• USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or
specifications, to include utilities locate requirements and use limitations/requirements of easements, public
right-of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be
saved harmless by the USER from any of the work herein under the terms of this permit and that all of said
liabilities are hereby assumed by the USER. ]]''��'p,,pp
4I,/ 0
� Date I '7-0)0d-0
Property(t&Drtk
e (signe presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this day of , 20
by v ' �( ,who personally appeared before me and
(print name of Signer
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
Department Approval:
Signature of Notary Public,State of Florida
[ ] Personally Known
[ ] Produced Identification(Type) Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18